Male Circumcision in Namibia Frieda Katuta National Prevention
Male Circumcision in Namibia Frieda Katuta National Prevention Coordinator Namibian Ministry of Health and Social Services
HIV in Namibia • Population: ~ 2 million • 2008 prevalence among pregnant women (15 -49) 17. 8% • 2008 adult (15 -49) prevalence estimate modeled at 15. 3% (generalized epidemic) • 204, 000 PLWHA in 2008
21% Males Circumcised in Namibia Varies widely by region Percent of men who report being circumcised, Namibia DHS 06 -07 Although the association isn’t perfect, some regions w/ highest MC prevalence (Kunene & Omaheke, >50%) also contain the ANC sites w/ lowest HIV prevalence (Opuwo & Gobabis, 8%)
5 -Step MC Situational Assessment Completed in 2009 1. Desk review of available MC data and mapping of facilities 2. Qualitative research on MC acceptability • • Key informant interviews Focus group discussions 3. Facility readiness survey 4. Costing and impact analysis of rolling out MC 5. Stakeholders meeting – to share results and develop draft policy and draft action plan
Implementation Status • MC Task Force functioning since 2007 • 3 Pilot Sites operational since Sept 2009 • 350 MC procedures have been carried as of June 1 st, 2010 – ~90% have been tested for HIV • 83 individuals trained in 4 trainings since 2009
Policy & Regulation • MC Policy has been drafted – 3 rd version resubmitted for government approval (June 2010) • Action plan (i. e. , Implementation Strategy) drafted, will be revised based on policy approval • MC targets included in new National HIV Strategic Framework (2010 -2016)
Communications • Communication Strategy Developed – – Comprehensive MC Booklet for Clients General MC Information leaflet for General Public Poster Comprehensive MC “information kits” for Policymakers, healthcare and media workers • Champions visit from Southern African Leaders advocated for MC in Namibia • Various newspaper articles on MC • Demand creation not started to date
Challenges • • • Continue in “Pilot” phase--no national roll out MC only in government integrated sites Policy approval process Inadequate human resources to support MC Delays in task shifting/ task sharing guidance from Health Professional Council No electronic M&E system and general M&E needs to be strengthened and scaled-up (e. g. , Inadequate supervisory visits) Support and interaction between Mo. HSS and traditional circumcisers delayed Primarily PEPFAR-funded No neonatal circumcision to date
Human Resource Challenges and Solutions • National MC Coordinator position filled Jan 2010 • Dedicated doctor/nurse teams hired for 3 pilot sites June 2010 • Negotiating with Nursing and Health Professional Council for task sharing and task shifting guidelines for MC • Collaborating with WHO to participate in the volunteer doctor program
Lessons Learned – Importance of a systematic evidence-based situational assessment provided support and influenced political will – Coordinate with VCT from onset – Communications material essential for health care workers and general public – Costing data assisted with GRN support – Policy approval can delay the implementation process – Need adequate human resources
Key Next Steps for 2010 -2011 • • Circumcise!!! Dedicated teams in place in 3 sites Expand beyond pilot sites Pilot WHO volunteer program Expand frequency of training to support aggressive country-wide roll out Initiate demand creation and proactive communication Consider MC in sites in addition to public health facilities Enhance relationship with traditional circumcisers Adapt efficiency models (e. g. , MOVE, etc. )
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